human factors awareness : the foundations for compassionate safe care professor jane reid 1...

Human Factors Awareness : The Foundations for compassionate safe

care

Professor Jane Reid

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Compassionate safe Care

Focus

• Explore compassionate care in context and the emotional labour of caring

• Examine compassion and care as a shared right of the ‘cared for’ and their ‘care givers’

• Discuss how human factors awareness/understanding (Board/frontline) can build emotional and organisational resilience, to support staff in their care giving role

• Outline the recent work of the NQB to establish ways of integrating human factors understanding and application at scale in the NHS

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“Enhancing clinical performance

through an understanding of the

effects of teamwork, tasks,

equipment, workspace, culture and

organisation on human behaviour

and abilities and application of

that knowledge in clinical settings”

Catchpole 2010


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Care is our

business

Compassion

Co

mp

etence

Communication

Courage

Co

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itm

ent

CNO focus on 6Cs for Nursing.

…but can policy direct compassion and what of the rest of the workforce ?


Compassion, or caring is “nursing’s (healthcare’s) most precious asset

(Schantz, 2007)

a fundamental element of nursing/health care one of the strengths of the professions

(Dietze and Orb, 2000)

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Six essential elements of caring

confidence competencecompassionconsciencecommitment comportment (attitude)

Roach (2002)6


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Production science and systems engineering can enhance the way we organise care delivery

but misused, misunderstood or cherry picked ‘lean’ tools to contain cost vs driving continous quality patient experience can be catastrophic

People are not widgets


What is compassion?

• Empathy, respect, a recognition of the uniqueness of another individual, and the willingness to enter into a relationship in which the knowledge, intuitions, strengths, and emotions of the patient and the physician can be fully engaged

Lowenstein (2008)

• A deep awareness of the suffering of another

coupled with the wish to relieve it Chochinov (2007)

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One of our challenges

is that everyone

will have their own personal, subjective definition

Personal definitions fit in with our own view of the world, but may have little in common with the views of others.

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Compassionate safe care

Compassion & Quality




Human Factors : shared mental models

The perception of, understanding of orknowledge of a situation or process, that is shared among the team through communication

Teams with shared mental models perform well

Rouse et al 1992Orsanu 1999Mathieu et al 2000Salas 2010

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Compassion involves

Generosity and kindness

Valuing otherness

Awareness and recognition (self and situation awareness)

Honesty

Dialogue

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Compassionate and safe Care

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Self & Situation Awareness

compassionate care is more than the competent execution of clinical skills

it involves a “doing role” and a “being role”.

it is vital to patients that they are “cared for” and “cared about”

(National Nursing Research Unit, 2008)14



Expressive Caring=

Compassionate Caring

Emotional Labour of Caring

Compassion Fatigue

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http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=PR1DB7FWO1H1HM&tbnid=7oAyzCD5iGZ10M:&ved=0CAUQjRw&url=http%3A%2F%2Ffilipinonurses.org%2Findex.php%2F2012%2F04%2Ftop-five-demons-every-filipino-nurse-must-kill%2F&ei=hLc3UauKNuOx0QX9z4GYCQ&bvm=bv.43287494,d.d2k&psig=AFQjCNHgDjMgbBmiu9k49dXe7q__akye_A&ust=1362692264094837

Discussion Point

Identify the factors that contribute to compassion fatigue and the potential to avoidable harm

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http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=PR1DB7FWO1H1HM&tbnid=7oAyzCD5iGZ10M:&ved=0CAUQjRw&url=http%3A%2F%2Ffilipinonurses.org%2Findex.php%2F2012%2F04%2Ftop-five-demons-every-filipino-nurse-must-kill%2F&ei=hLc3UauKNuOx0QX9z4GYCQ&bvm=bv.43287494,d.d2k&psig=AFQjCNHgDjMgbBmiu9k49dXe7q__akye_A&ust=1362692264094837

Organisational Factors

• Conditions of work • Nature of the work• Poor Design • Lack of standardisation• Flawed systems and

processes• Inability to give of one’s

best

Staff Factors

• Experience• Training and preparation• Supervision• Morale• Mental and physical health• Tiredness• Distraction• Multi-tasking• Resilience

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Crucial Board Conversations

Factors that increase potential for error/harm/compassion fatigue

Discussion Point

If we were designing a quality service would we advocate 12 hour shift patterns ?

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Schwartz Center Rounds®

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The Point of Care Foundation Transforming the experience of healthcare for patients and staff

“The failings at Mid Staffordshire NHS Foundation trust were an extreme example of what can go wrong when there is a poor organisational culture.

But seeing the person in the patient, and supporting staff in the difficult work of care, even when it is delivered on an industrial scale with tight resources and competing demands is always going to be a challenge”.

Director Jocelyn Cornwell

Strengthening compassionate quality care-giving

• Communicating commitment

• Acknowledging the challenges and the costs to our care givers

• Active visible leadership for safety and compassionate care

• Strengthening patients’ and relatives’ voice in the system

• Actively developing managers’ relational skills

• Investing in Human Factors awareness and understanding for the workforce

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Compassionate Care Requires

1) Nurture an Essential Mindset

Not on my watch !

2) Create the conditions for Action ( Empowerment)

Choosing to act choosing to be counted !

3) Foster Leadership commitment

…………to the conditions/context and carer/care giver

to make it easier to do the right thing


The synergies of Safety Science/Human Factors/ Nursing Theory

Nursing Theory

Being ‘present’

The art of ‘being’

‘therapeutic engagement’

Non-technical skills

Self awareness

Situation awareness

System awareness

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Category Element

Task Management Planning and preparation

Prioritisation

Providing and maintaining standards

Identifying and utilising resources

Team Working Co-ordinates activities with team members Information exchange Use of authority and assertiveness Assessment of capabilities of team and self Supporting others

Situation Awareness Gathering information Understanding and recognition Anticipation

Self Awareness Recognition of the impact of self

Decision Making Identifying Balancing risks and selecting options Re-evaluation

Recognise the contribution of non technical skills


We engage with/respond to patients, relatives and our colleagues by

• serving• committing (individually and corporately)• advocating and challenging• ‘following through’• delivering

Being Present and therapeutic engagement is about social, emotional, ethical, professional conscience?


• better performance under pressure (you're focused)

• improved listening and memory skills (you're "present-minded", not "absent-minded")

• better conflict resolution (you don't get emotionally 'triggered')

• awareness of system flaws and the organisational barriers to giving good care

Performance benefits of being present/therapeutic engagement


• more persistence and ability to learn (you are more patient and tolerant of difficulties)

• wiser, clearer decisions (you don't react out of habit)

Performance benefits of being present/therapeutic engagement


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Maintain Identity:

‘See who I am’


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Creating Communities:

‘Connect with me’


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Share Decision Making:

‘Involve me’


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Care is our

business

Compassion

Co

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etence

Communication

Courage

Co

mm

itm

entExercise

What are you doing in your organisation to

1) integrate human factors awareness in all that you do ?

2) to build compassionate caring cultures ?


HUMAN FACTORS

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There are two primary choices in life;

to accept conditions as they exist or

accept the responsibility for changing

them

Denis Waitley


November 2013

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Concordat Signatories

Care Quality Commission Department of Health

Health Education England NHS England NHS Employers NHS Trust Development Authority

Monitor National Institute for Health and Care Excellence

General Medical Council HealthWatch England

Nursing and Midwifery Council Public Health England

Social Care Institute for Excellence NHS Leadership Academy

NHS Litigation Authority

The Parliamentary & Health Service Ombudsman for England


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Commitment

The NQB

believes that a wider understanding of Human Factors principles and practices will contribute significantly to improving the quality of care for patients.

will support the NHS to optimise leadership, systems and processes, design, education and training, regulation and quality assurance, to build a high preforming, resilient and efficient healthcare system

will provide leadership and oversight for embedding Human Factors principles and practices at all levels of the system


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What is happening


Developing expertise in human factors science and root cause analysis to help providers learn from Complaints through better understanding of why mistakesHappen

Developing a safety and learning service and library ofresources including human factors so that organisationscan get to the heart of why claims occur and how they canbe prevented in future

Ensuring Human Factors approaches are embedded in all of its programmes and online materials and included in conversations with partners, participants and patients

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Acknowledgements

The Concordat is the starting point

For our ambitions to become a reality Human Factors principles and practices mustinform all aspects of the healthcare system

Not just about one thing, but multiple actions at multiple levels

Commitment of organisations to embed in ‘business as usual’ and when things gowrong/require investigation to maximise the potential of human factors


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It isn’t rocket science !! • Value and take care of staff• Equip the front line with human factors

awareness and understanding• Encourage and reward leadership for

safety/care/caring• Role model professional behaviours• Value communication at every level• Identify and correct flawed systems• Remember that little things make a big

difference!


Human Factors Awareness : The Foundations for compassionate safe

care

Professor Jane Reid

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